Name: Veterinarian
Brand: Roaring Fork Equine Medical Center

Owner’s Name

Email

Phone (home)

Phone (cell)

Secondary Contact

Mailing Address

Patient’s Name

Color

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Age

Breed

I am the owner or agent for the above named patient and have authority to execute this consent. I hereby consent and authorize the performance of the following medical and/or surgical treatments/procedures as recommended by the veterinarian. For example: colic treatment, lameness evaluation.

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I understand that during the performance of these procedures unforeseen conditions may develop or be revealed that necessitate additional treatment. Therefore, I hereby consent to and authorize the performance of treatments deemed necessary in the exercise of the veterinarian’s best professional judgment. These may include the use of appropriate anesthetics, medications, and/or restraint. I understand that results cannot be guaranteed and that risks are involved with any operation. To this end I authorize the employees of Roaring Fork Equine Medical Center to provide services to the above named patient.

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Date

RFEMC’s Visitation Policy Visitation is by appointment, in one hour increments between the hours of 9-5, Monday-Friday. This allows us to be sure to have staff on hand to answer questions and facilitate hand walks or other activities. Please respect this policy as it is our goal to maintain a peaceful and safe environment for all patients and owners.

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Consent Form

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